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Assessing risk in liver transplantation: Special reference to the significance of a positive cytotoxic crossmatch

Doyle, HR and Marino, IR and Morelli, F and Doria, C and Aldrighetti, L and McMichael, J and Martell, J and Gayowski, T and Starzl, TE (1996) Assessing risk in liver transplantation: Special reference to the significance of a positive cytotoxic crossmatch. Annals of Surgery, 224 (2). 168 - 177. ISSN 0003-4932

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Abstract

Objective: The authors determined the impact of a positive cytotoxic crossmatch on the outcome of liver transplantation. Summary Background Data: Liver allografts rarely undergo hyperacute rejection, but transplants performed across a positive cytotoxic crossmatch tend to follow a different clinical course, with higher intraoperative blood use, postoperative graft dysfunction, and, in some oases, graft loss. How this affects overall graft survival has not been determined. Methods: The authors provide a retrospective analysis of 1520 liver transplants performed between November 1989 and December 1993, with a minimum follow-up of 1 year. All cases had a cytotoxic crossmatch using serum pretreated with dithiothreitol. Results: There were 1390 negative crossmatch and 130 positive crossmatch cases. There was no difference in overall graft survival, although early survival rates were lower in the positive crossmatch group, with the maximum difference at 6 months: 0.76 (95% confidence interval, 0.74-0.78) for a negative crossmatch versus 0.68 (95% confidence interval, 0.61- 0.77) for a positive crossmatch. These differences become negligible by the 2- year mark. Using stepwise logistic regression, the authors identified seven variables independently associated with outcome: 1) donor age, 2) donor gender, 3) prior liver transplant, 4) medical urgency status, 5) ischemia time, 6) indication for transplantation, and 7) primary immunosuppressant. Conclusions: The cytotoxic crossmatch is not statistically associated with overall graft survival after liver transplantation. However, early failure rates are higher in the positive crossmatch cases, a difference that disappears by the second year.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Doyle, HR
Marino, IR
Morelli, F
Doria, C
Aldrighetti, L
McMichael, J
Martell, J
Gayowski, T
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 27 August 1996
Date Type: Publication
Journal or Publication Title: Annals of Surgery
Volume: 224
Number: 2
Page Range: 168 - 177
DOI or Unique Handle: 10.1097/00000658-199608000-00009
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0003-4932
Other ID: uls-drl:31735062133222, Starzl CV No. 1858
Date Deposited: 08 Apr 2010 17:31
Last Modified: 14 Oct 2017 11:55
URI: http://d-scholarship.pitt.edu/id/eprint/5244

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